Sozzi Giulio, Lauricella Sonia, Cucinella Giuseppe, Capozzi Vito Andrea, Berretta Roberto, Di Donna Mariano Catello, Giallombardo Vincenzo, Scambia Giovanni, Chiantera Vito
Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Obstetrics and Gynecology, Fondazione Istituto G. Giglio, Cefalù, Italy.
Department of Obstetrics and Gynecology, Fondazione Istituto G. Giglio, Cefalù, Italy.
Eur J Surg Oncol. 2023 Nov;49(11):107102. doi: 10.1016/j.ejso.2023.107102. Epub 2023 Sep 28.
The historical approach to LEER is laparotomic, but recently laparoscopy has been proposed. The objective of this study was to compare surgical and oncological outcomes between the two approaches and to assess the overall quality of life (QoL).
Women submitted to LEER between October 2012 and March 2020 were retrospectively recruited. Peri-operative data were analyzed and compared. Recurrence-free (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-CX24, and QLQ-OV28 questionnaires were administered 6 months after surgery in women with no evidence of recurrence after LEER.
Of the included 41 patients, 20 were submitted to laparoscopic LEER (L-LEER) and 21 to open LEER (O-LEER). Median operating time (442 vs 630 min, p = 0.001), median blood loss (275 vs 800 ml, p < 0.001), and median length of hospital stays (10 vs 16 days, p = 0.002) were shorter in the laparoscopic group, while tumor resection rate and peri-operative complications were similar. After a median follow-up of 27.5 months, no differences, in terms of DFS (p = 0.83) and OS (p = 0.96) were observed between the two approaches. High functional scores and low levels of adverse symptoms were observed on the surviving women.
QoL after LEER is acceptable, and laparoscopy provides better surgical and similar oncological outcomes when compared to laparotomy. L-LEER can be considered a further option of treatment for women with gynecological tumors infiltrating the pelvic sidewall.
根治性广泛子宫切除术（LEER）的传统手术方式是开腹手术，但近年来有人提出采用腹腔镜手术。本研究的目的是比较两种手术方式的手术和肿瘤学结局，并评估总体生活质量（QoL）。
回顾性招募了2012年10月至2020年3月期间接受LEER手术的女性患者。分析并比较围手术期数据。采用Kaplan-Meier法计算无复发生存期（RFS）和总生存期（OS）。对LEER术后6个月无复发迹象的女性患者，使用欧洲癌症研究与治疗组织（EORTC）的QLQ-C30、QLQ-CX24和QLQ-OV28问卷进行评估。
纳入的41例患者中，20例行腹腔镜LEER（L-LEER），21例行开腹LEER（O-LEER）。腹腔镜组的中位手术时间（442 vs 630分钟，p = 0.001）、中位失血量（275 vs 800毫升，p < 0.001）和中位住院时间（10 vs 16天，p = 0.002）均较短，而肿瘤切除率和围手术期并发症相似。中位随访27.5个月后，两种手术方式在无病生存期（p = 0.83）和总生存期（p = 0.96）方面未观察到差异。存活女性的功能评分较高，不良症状水平较低。
LEER术后的生活质量是可以接受的，与开腹手术相比，腹腔镜手术具有更好的手术效果和相似的肿瘤学结局。L-LEER可被视为治疗浸润盆腔侧壁的妇科肿瘤女性患者的另一种选择。
